January 2002: Tricks of the Trade

Contributed by readers. Edited by Donald B. Middleton, MD

DOES THE ABDOMINAL PAIN REMAIN?

Occasionally, a testimonial about the usefulness of a particular medication in aiding a diagnosis may lead to a more detailed study that can refute or support the suggested stratagem. One such possibility is a proposal from Dr. Bernice Rodrigues of Castro Valley, California, who finds that 0.625 mg of droperidol given intravenously can help determine whether abdominal pain has any significant underlying pathologic cause. This drug is a mild sedative and antiemetic that relieves cramping and spasms with minimal adverse effects. Dr. Rodrigues claims that in her experience, an absence of abdominal tenderness after the administration of low-dose droperidol supports a nonserious etiology. Persistent tenderness, on the other hand, suggests something more significant and dictates further testing. Almost all physicians shun the administration of medication before establishing a diagnosis. Perhaps droperidol will prove to be the exception.

RECAPPING SAFELY

Puncture-resistant disposal containers are often tough to come by in developing countries. To reduce the risk of transmitting blood-borne pathogens, the recapping of needles is crucial. To avoid the risk of needling himself during the process, Dr. Khin Maung Aye (Hein), of Yangon, Myanmar, drills holes at the edge of the injection preparation table at an angle of 15º. The holes are slightly larger than the needle cap but smaller than the collar of the cap. He places the needle cap into the hole before giving the injection, then he uses just one hand to place the needle back into the cap once the injection is completed.

GOOD POINT

Need an instrument to infiltrate an anesthetic into small or medium-sized lacerations? Certified registered physician's assistant Claudia J. Radist of New York City recommends insulin syringes equipped with 28.5-gauge needles.

GUMMING UP A FRACTURED TOOTH

Patients often present to emergency medicine physicians with a cracked tooth that is irritating the tongue or buccal mucosa. Dr. Mark Silverberg of Brooklyn, New York, has a suggestion for a very temporary fix that will suffice until final dental repair can be accomplished. He tells his patients to chew some gum and then spread it with their tongue over the surface of the cracked tooth. This will prevent the sharp fragment from doing any more damage to the soft tissues of the mouth.

STY-LISH ADVICE

To drain a hordeolum or sty, Dr. Silverberg follows this simple rule: Excise the external hordeolum horizontally and the internal hordeolum vertically. His explanation makes excellent sense. Externally, the incision will match the direction of lines of tension on the skin, promoting good cosmetic healing. Internally, the incision will be parallel to the direction of lid motion when blinking, thereby causing less corneal irritation.

EASY WAY OUT FOR SWIMMER'S EAR

To soothe sore ears in patients with otitis externa, Dr. Peter Teichman of Shepherdstown, West Virginia, soaks an Oto-wick in EMLA cream (a eutectic mixture of local anesthetics consisting of lidocaine and prilocaine in an emulsion base) before inserting it into the swollen ear canal. The EMLA eases insertion and decreases pain while the wick slowly opens the canal to allow drainage.

TICK TALK

The standard method of tick removal is simply gentle traction to pull the tick out. Another approach comes from Dr. Robert J. Eckerson of Vernon, New Jersey. He applies a dollop of lidocaine 2.5% ointment over the tick before he attempts the removal. After several minutes, he wipes away excess lidocaine and removes the tick with a gentle but firm tug, using his gloved fingers, a gauze pad, or smooth forceps. Some authorities claim, however, that the coat of lidocaine (or any other ointment or jelly) causes the tick to suffocate, which increases the risk of a terminal regurgitation of intestinal pathogens-such as Borrelia burgdorferi, the cause of Lyme disease-into the wound. A controlled trial might help resolve this issue, but a good start would be to observe the morbidity that occurs after various methods of tick removal have been tried.